Israel Health Ministry: Use of ADHD drugs soars by 76% in 2010

Health Ministry figures show the steepest increase since surveillance on Ritalin and Concerta marketing in Israel began in 1993.

The use of Ritalin and Concerta, drugs for treating attention deficit disorders, has soared by 76 percent in one year, Health Ministry figures show.

The 2010 figures show the steepest increase since surveillance on Ritalin and Concerta marketing in Israel began in 1993. The surveillance is required since these drugs contain the active ingredient methylphenidate, which is classified in Israel as a dangerous drug.

Ritalin, a central nervous system stimulant that affects chemicals in the brain and nerves, is used to treat attention deficit disorder (ADD ) and attention deficit hyperactivity disorder (ADHD ). Ritalin is also used in the treatment of a sleep disorder called narcolepsy (an uncontrollable desire to sleep ).

Ministry figures recently passed on to Citizens Commission on Human Rights, a psychiatric and human rights violations watchdog, show 621 kilograms of methylphenidate were issued in 2010, compared with 352 kilograms in 2009.

Health Ministry officials say the rise reflects the growing awareness of ADD and the improvement in the drug's effectiveness in treating the disorder.

The ministry attributes the increase to adults' use of Ritalin and Concerta as well as children, and to the approval, in 2010, of raising the daily Ritalin dosage from 60 milligrams to 90.

"Until the end of 2009 the amount of Ritalin was limited to 60 mg, too little for the treatment of adolescents weighing 50-60 kgs and adults," says Professor Asher Ornoy, Head of the Dept. of Child Development in the Health Ministry.

"Since 2010 it is possible to prescribe up to 90 mg a day, which enables effective dosage and raises the consumed amount by tens of percent," he says.

Ornoy says the estimated number of Ritalin and Concerta users - 55,000 - is low compared to the number of ADD patients, which is estimated at more than 100,000.

Dr. Iris Manor, head of the ADHD unit at Geha Psychiatric Hospital, Petah Tikva, says "most of the children treated with the drug still need treatment as adults. In addition, awareness of the drug among adults who have not been diagnosed with ADD as children is growing."

The dosage difference between Ritalin and Concerta, stemming from the different mechanism of active-substance release in the body, could also explain part of the rise in the drugs' use.

Another factor is growing awareness of learning disabilities. In the past two years about a tenth of children have been diagnosed with learning disabilities at school, says Ornoy. Almost every child with learning disabilities is sent to be examined by an ADD specialist.

"In my experience, a considerable number of children sent for examination do not have an attention disorder," says Ornoy. "However, due to Ritalin's high effectiveness, the number of treated children is constantly rising," he says.

The consumption increase also reflects a ministry policy introduced two years ago, enabling family doctors and pediatricians who have undergone special training to prescribe Ritalin and Concerta.

"There is a very long wait - from about six months to a year - for diagnosis by a specialist psychiatrist or neurologist (respectively ) to begin treatment with the drug," Manor says.

The Health Ministry said "the assumption is that if the rise in Ritalin use continues in 2011 it will be relatively moderate."

Haaretz reported in July that the IDF had begun recruiting soldiers who are treated with ADD drugs. Some 5 percent of those with attention deficit disorders do not respond to Ritalin and Concerta and need alternative drugs that are not included in the state-subsidized medicines.

A study published last March by Dr. Shlomo Antebi, of the Maccabi Health Maintenance Organization, found that thousands of Israeli children are prescribed Ritalin without first undergoing an examination for accompanying psychological problems as required.

Consequently, up to 20 percent of the children are treated with Ritalin even though they do not need it, the study says.